Trends in labor induction indications : A 20-year population-based study

• Published in: Acta Obstetricia et Gynecologica Scandinavica
• Main Authors: Swift, Emma Marie, Gunnarsdóttir, Jóhanna, Zoéga, Helga, Ingibjörg Bjarnadóttir, Ragnheiður, Steingrímsdóttir, Þóra, Einarsdóttir, Kristjana
• Other Authors: Faculty of Nursing and Midwifery, Faculty of Medicine, Other departments, Women's and Childrens's Services, Landspitali - The National University Hospital of Iceland
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2022
• Subjects: Fæðinga- og kvensjúkdómafræði; elective; epidemiology; indication; labor induction; maternal request; Humans; Risk; Pregnancy; Prolonged; Cesarean Section; Maternal Age; Female; Labor; Induced/methods; Obstetrics and Gynecology; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/3487; https://doi.org/10.1111/aogs.14447

© 2022 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Funding Information: This study was funded by the University of Iceland Research Fund (Rannís). Helga Zoega was supported by a UNSW Scientia Program Award. Publisher Copyright: © 2022 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). INTRODUCTION: Use of labor induction has increased rapidly in most middle- and high-income countries over the past decade. The reasons for the stark rise in labor induction are largely unknown. We aimed to assess the extent to which the rising rate of labor induction is explained by changes in rates of underlying indications over time. MATERIAL AND METHODS: The study was based on nationwide data from the Icelandic Medical Birth Register on 85 620 singleton births from 1997 to 2018. The rate of labor induction and indications for induction was calculated for all singleton births in 1997-2018. Change over time was expressed as relative risk (RR), using Poisson regression with 95% confidence intervals (CI) adjusted for maternal characteristics and indications for labor induction. RESULTS: The crude rate of labor induction rose from 12.5% in 1997-2001 to 23.9% in 2014-2018 (crude RR = 1.91, 95% CI 1.81-2.01). While adjusting for maternal characteristics had little impact, adjusting additionally for labor induction indications lowered the RR to 1.43 (95% CI 1.35-1.51). Induction was increasingly indicated from 1997-2001 to 2014-2018 by gestational diabetes (2.4%-16.5%), hypertensive disorders (7.0%-11.1%), prolonged pregnancy (16.2%-23.7%), concerns for maternal wellbeing (3.2%-6.9%) and maternal age (0.5%-1.2%). No indication was registered for 9.2% of inductions in 2014-2018 compared with 16.3% in 1997-2001. CONCLUSIONS: Our results show that the increase in labor induction ...